Diabetes Self-Management Education (DSME) Mini-Grant Funding Opportunity Announcement (FOA) FY 2017 - 2018 Deadline for application: November 1, 2017 I. Overview A. Diabetes Self-Management Education People with diabetes who complete a diabetes self-management education (DSME) class are better able to manage their disease and prevent or delay complications. DSME is NOT a 24-hour nurse hotline or a brochure. Rather, it is a comprehensive, evidence-based approach to disease management that meets national standards. To ensure DSME services adhere to these evidence-based standards, the Centers for Medicare and Medicaid Services (CMS) authorizes the American Diabetes Association (ADA) and the American Association of Diabetes Educators (AADE) to certify DSME programs as meeting the national standards. CMS only reimburses DSME services provided by organizations that are recognized by the ADA or accredited by the AADE. The designation of ADA recognition or AADE accreditation assures participants in these DSME programs that they are receiving quality, evidence-based services. Prior to responding to this funding opportunity announcement, please review the following websites and resources for information regarding DSME. AADE Website: https://www.diabeteseducator.org/ ADA Website: http://www.diabetes.org/ Crosswalk for AADE’s Diabetes Education Accreditation Program: https://www.diabeteseducator.org/docs/default-source/legacy- docs/_resources/pdf/accred/Final_Crosswalk_-_3-2013.pdf National Standards for Diabetes Self-Management Education and Support: http://care.diabetesjournals.org/content/37/Supplement_1/S144.full-text.pdf B. The Florida Diabetes Alliance The Florida Diabetes Alliance is a statewide, grassroots coalition and a 501C3 non-profit organization. Members include health care professionals, health care facilities, insurers, community-based organizations, faith-based organizations, and interested individuals or entities. The Alliance promotes access to quality diabetes prevention, education, and care resources. Since 2009, members of the Alliance have provided mentoring technical assistance to organizations in Florida seeking ADA recognition or AADE accreditation of their DSME programs. Mentors have experience auditing DSME programs for the ADA or the AADE or with operating an accredited or recognized DSME program. The Alliance provides these services to DSME mini-grantees. Recently, the focus of the mini-grant program, as well
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Prepare a response to all sections. All questions must be answered. You may use a narrative style, but your
responses should follow the order in which the questions are asked. This section of the application must be
double-spaced and must not exceed 10 pages. Only Microsoft Word (doc, docx) or PDF formats are acceptable.
Font size must be 11 points or greater. Handwritten applications will not be accepted.
1. What objective(s) are you applying for? List all that apply. Applicant response should align with one or
more of the following objectives.
Objective 1: Build infrastructure that aligns with national standards for DSME programs. Objective 2: Achieve DSME accreditation or recognition. Objective 3: Establish a recognized or accredited satellite site. Objective 4: Increase sustainability of an existing recognized or accredited DSME program. Objective 5: Increase access to a recognized or accredited DSME program by people with physical or
intellectual limitations.
2. Why is your organization requesting these funds? How would your organization use these funds?
Explain how the proposal addresses the needs of the population which the applicant serves or will serve.
THESE FUNDS MAY NOT BE USED FOR DIABETES PREVENTION PROGRAMS.
3. Describe your organization’s knowledge of and experience with providing diabetes education services.
4. Describe your organization leadership’s support for current diabetes programs and for activities that
would be funded by this funding opportunity, including support after the funding period ends.
5. List the counties in which your organization provides diabetes management services, and the type of
services provided. Note if your organization currently provides services in any of the following counties:
Alachua
Bay
Bradford
Charlotte
Calhoun
Citrus
Collier
Columbia
DeSoto
Dixie
Escambia
Franklin
Gadsden
Gilchrist
Glades
Gulf
Hamilton
Hendry
Hernando
Holmes
Jackson
Jefferson
Lafayette
Lake
Lee
Leon
Levy
Liberty
Madison
Marion
Okaloosa
Putnam
Santa Rosa
Sarasota
Sumter
Suwannee
Taylor
Union
Wakulla
Walton
Washington
6. List counties in which proposed services would occur. Note whether any of the counties listed above are
included in your proposed service area.
7. What type of agency is your organization? For-profit, not-for-profit, government, or other. (If other,
explain.)
8. Describe your organization’s billing experience: Does your organization currently (or within the last year)
bill Medicaid, Medicare, or private insurance for any services?
9. Please describe your organization’s ability to staff a DSME program. Include details such as the number
of full- and part-time employees dedicated to the program, leadership buy-in, other funding sources for
staff, etc. Staffing must be described in more detail in the budget request and budget narrative
(Attachment 3).
9a. Who coordinates (or would coordinate) your DSME program? Include credentials, employment
history, and diabetes-related experience.
9b. Describe the staff who are currently involved in diabetes education or management. Include the
following information for each staff member:
Name and Credentials (If position is vacant, show TBD or new position)
Position Title
Is this a current position?
Is this position full-time? If not, how many hours per week?
Is this position contracted?
What percent of this staff member’s time is devoted to DSME?
What is the funding source for this staff member?
10. How does your current program incorporate accessibility for participants with physical/intellectual
disabilities? How would you use these funds to increase accessibility? Examples include ease of
wheelchair access, covered portico, sign language interpreter provided, large-text documents, or other
ways in which the organization is inclusive of people with disabilities. (Answer this question even if you
are not requesting funds under Objective 5.)
11. Describe the organization’s infrastructure and ability to provide the services for which the funds will be
used. Include how current services will be expanded and how proposed objectives will be accomplished.
Include current internal and external policies, procedures, and agreements that impact your ability to
achieve your goal(s). If you are proposing new collaborative opportunities, include letters of support or
copies of memoranda of agreement that demonstrate that prospective partners have agreed to participate
and how they will assist the applicant in achieving the stated goals. (Letters of support/memoranda of
agreement are not included in page count.)
12. What is your plan for sustainability of the DSME program after the funding period ends? If requesting staff expenses to be paid from this funding opportunity, include a plan for sustaining these positions after the funding ends.
13. Provide three community references (outside your organization) who can speak to your organization’s
capability and commitment to provide diabetes education services. For each reference, provide the
2017-2018 DSME MINI-GRANT BUDGET REQUEST AND BUDGET NARRATIVE (REQUIRED)
Budget: Complete this budget request form. You may copy and paste it into an Excel spreadsheet. Your request will be considered, but it is not guaranteed that you will receive your full funding request. Also, the review committee might authorize or require items to be funded that are not included in your budget request. STAFF:
Put the name (or TBD if currently not hired) and position of each staff member who will provide support for this project on a separate line under Column A. Note the annual salary in Column B, the percent of time the staff person will devote to the DSME project in Column C, and the total amount charged to the DSME project in Column D. The amount in Column D should be no more than Column B x Column C.
Fringe benefits for all staff may be combined on one line in the table. Put N/A if no fringe is requested. EXPENSES
Only expenses for this project should be included in Column B. Add lines if needed.
Only note the total for each expense category in the budget form. For example, on the professional education registration fees line, only note the total in Column B. Each registration fee will need detailed justification in the budget narrative.
BUDGET REQUEST FORM
A. Budget Category B. Total C. Percentage Allocated to
Budget Narrative: Provide a budget narrative with detailed information and justification for each line item on the Budget Request Form. Budget narrative should be single-spaced.
Salary/Fringe:
Show all staff assigned to this project, including percent of time dedicated to the project and funding
to be paid from this project. Identify the staff member who serves (or will serve) as program
coordinator.
Include the following information for each staff member currently involved or proposed to be added to
the DSME program:
Name and Credentials (If position is vacant, show TBD or new position)
Position Title
Is this a current position?
Is this position full-time? If not, how many hours per week?
Is this position contracted?
What percent of this staff member’s time is devoted to DSME?
What is the funding source for this staff member?
If requesting staff expenses to be paid from this project, include justification and sustainability for
position funding at conclusion of the grant funding period.
Project Supplies:
Include a description of the items you intend to purchase and the total amount requested. Describe
how the requested supplies will benefit the project.
Travel:
List amount requested for travel and the purpose of the travel. If particular travel details are known,
include details such as dates and location. Describe how the requested travel will benefit the project
Travel will be reimbursed per State of Florida guidelines (Attachment 4).
Professional Education Registration Fees:
If specific events are known, include details such as dates, location, and event title. List each event
separately. Describe how participation in the requested event will benefit the project
Professional Memberships:
List organization, cost of membership x number of memberships, total price, name(s) of staff, benefit
to the project
Printing:
Include as much information as possible: a description, quantity, price each, total price for each item
requested. Describe how the requested materials will benefit the project.
Other:
If items are requested that do not fit in any of the above categories, enter them as “Other” and
Meals – Only allowable for overnight travel more than 50 miles (one-way) from headquarters or residence city. Reimbursement rates are as follows: a) Breakfast - $6 (When travel begins before 6 A.M. and extends beyond 8 A.M.)
b) Lunch - $11 (When travel begins before 12 Noon and extends beyond 2 P.M.)
c) Dinner - $19 (When travel begins before 6 P.M. and extends beyond 8 P.M.)
Meals included in a registration fee shall be deducted from the meal allowance or per diem rate Per Diem or Actual Lodging Expenses – Only allowable for overnight travel more than 50 miles (one-way) from headquarters or residence city. a) Lodging – Hotel reimbursements cannot exceed $150 per night.
b) Per Diem - Per-diem shall be calculated using four six-hour quarters beginning at midnight on the last day of travel. Per diem is $20.00 for each
quarter on the last day of travel.
Daily Per Diem Clock
Map Mileage Claimed--When a privately owned vehicle is used for business related travel, map mileage at a fixed rate of $0.445 per mile shall be
reimbursed. Travelers shall calculate the total mileage claimed out to the third decimal point and round down to the nearest cent when mileage is to be reimbursed. Map mileage claimed shall be from city to city and cannot exceed the total mileage shown on the FDOT Internet Web Page http://www2.dot.state.fl.us/CityToCityMileage/viewer. html or the current total mileage shown on the Florida’s Official State Transportation Map issued by FDOT. The Internet Web Sites listed can be used to calculate map mileage when cities are not listed on the Department of Transportation Official Highway Mileage web site. http://www2.dot.state.fl.us/CityToCityMileage/viewer. html http://maps.google.com, http://maps.yahoo.com
Vicinity Mileage Claimed – When privately owned vehicles are used for business related travel, vicinity mileage allowance at a fixed rate of $0.445
per mile shall be reimbursed. Travelers shall calculate the total mileage claimed out to the third decimal point and round down to the nearest cent when mileage is to be reimbursed.
Rental Car – Travelers are required to use Compact Class B vehicles except when the number of passengers or the volume of materials to be
transported makes use of a Compact Class vehicle impractical. Travelers will not be reimbursed for use of a car larger than the Compact Class B on the rental car contract because of the size or stature of the individual unless the requirements of the American with Disabilities Act (ADA) are met. a) Gas/Fuel Receipts – Itemized fuel receipts with the name and address of vendor, date and time of purchase, price per gallon, and quantity of fuel purchased and total cost required.
Airfare – Traveler must show that airfare is more cost effective than a rental car.
Taxi Fares – Receipts are required for taxi fares in excess of $25 on a per fare basis.
Parking Fees or Tolls – Receipts are required for parking fees or tolls in excess of $25 on a per-transaction basis.
Registration fees – Receipts or cancelled checks are required for registration fees.
Taxi Tip – Tips paid to taxi drivers shall not exceed fifteen percent of the taxi fare.
Valet Parking Tip – Actual amount paid for mandatory valet parking at the hotel not to exceed $1 per occasion. Valet parking tips shall not be paid if
self-parking is available at the hotel.
Portage – Actual portage paid shall not exceed $1 per bag not to exceed $5 per incident. The number of bags carried plus number of incidents are
ATTACHMENT 1: COVER SHEET (REQUIRED) ● Is cover sheet complete and signed?
Yes = 5
Partial = 3
No or not included = 0
ATTACHMENT 2: MINI-GRANT APPLICATION (REQUIRED)
1. What objective(s) are you applying for?
List all that apply. Applicant response
should align with one or more of the
following objectives.
● Does applicant state one or more of the
objectives listed below?
Yes = 10
No = 0
Objective 1: Build infrastructure that aligns with national standards for DSME programs Objective 2: Achieve DSME accreditation or recognition Objective 3: Establish a recognized or accredited satellite site Objective 4: Increase sustainability of an existing recognized or accredited DSME program Objective 5: Increase access to a recognized or accredited DSME program by people with physical or
ATTACHMENT 3: BUDGET REQUEST AND BUDGET NARRATIVE (REQUIRED)
BUDGET:
Complete this budget request form. You may
copy and paste it into an Excel spreadsheet.
Your request will be considered, but it is not
guaranteed that you will receive your full
funding request. Also, the review committee
might authorize or require items to be funded
that are not included in your budget request.
● Did the applicant include a budget on the
form provided?
Yes = 10
Partial = 5
No = 0
Personnel Salary and Benefits
Put the name (or TBD if currently not hired)
and position of each staff member who will
provide support for this project on a
separate line under Column A. Note the
annual salary in Column B, the percent of
time the staff person will devote to the
DSME project in Column C, and the total
amount charged to the DSME project in
Column D. The amount in Column D should
be no more than Column B x Column C.
Fringe benefits for all staff may be
combined on one line in the table. Put N/A
if no fringe is requested.
● Staff members’ names and titles are
included in Column A of the budget form,
and Columns B, C, and D are completed for
each staff member listed. Fringe benefits
are shown if applicable.
Yes = 10
Partial = 5
No = 0
Expenses
Only expenses for this project should be
included in Column B. Therefore, Column C
should be 100% for all expense items. If
another funding source is used to pay for
some of the materials, the amount in
Column D will be lower than the amount in
Column B. However, the amount in
Column D should not be higher than the
amount in Column B. Add lines if needed.
Only note the total for each expense category. For example, in the budget form, only note the total of professional education registration fees. Each item will need detailed justification in the budget narrative.